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Fri Jan 14 18:52:58 GMT 2005

And i'm sure you do a fine job Ben, as we've come to really enjoy working 
with our PA's now...in fact, trust their interpretation of what's going on 
with the patients more than any of the less than R3's.   It is in fact, 
our PA's that staff the hospital with us on Sundays and they are very 
involved in the emergency cases, enjoy the one on one interaction with the 
attending and participate in cases when residents aren't around....so that 
will probably be the workable solution to the issue of getting the work 
done and taking "care" of patients, but it is unfortunately, at the 
detriment to the resident. Perhaps we need to return to the days of the 
surgeon in training working as a mentee with a specific surgeon to learn 
specific things and be able to see the overall 'big picture' of patient 
care that we perform daily in the 'real world'....After all, our 
requirements post-residency are not a lot different: we have to care for 
patients, perform operations and learn about new techniques, constantly 
educate ourselves to stay up with best practices, perform the business 
side of our practice, see our families, eat, sleep - - all with no one 
monitoring our hours per week.....and i think i'm still pretty happy and 
healthy despite it all......
Jon

Ben Reynolds <aneurysm_42 at yahoo.com>
Sent by: trauma-list-bounces at trauma.org
01/14/2005 01:29 PM
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        To:     Trauma & Critical Care mailing list <trauma-list at trauma.org>
        cc: 
        Subject:        Re: Resident hours

I just want to add a few comments, as I work for the
University of Pittsburgh Medical Center department of
surgery in the role Jon described.

PAs and NPs role on academic surgical services should
be designed to optimize the residents' education,
which is now largely at a premium.  Keeping that in
mind, my energies are largely focused on herding
residents toward more productive activities which keep
them away from time consuming "scut" which leaves them
more time for operating, clinic, teaching rounds,
consults and other activies as directed by the
department.  In the afternoons, my goal is to get the
work done so that whichever resident has been on call
can leave in a way that effective sign out can be
performed.  Every Wednesday, I operate because all
residents are required to attend mandatory teaching
requirements, such as  service-specific teaching
conferences, grand rounds and clinic which takes up
the majority of that day.

The reality is that with a finite number of residents,
they can't be in all places at once and still keep the
program in compliance.  Therefore I field calls from
the floor, handle emergencies, see patients in the ED,
do consults and take patients to the OR emergently
when called to do so. 

I am NOT in competition with residents.  My formal
education is finished and I make an effort to not
burden myself from their "politics".  I do NOT steal
surgical cases.  I do NOT steal procedures.  I do NOT
unduly reduce the residents' workload such that the
character building experience of internship and
residency is lost in the rush to focus on meeting the
80 work week limit.  I consider myself to be a
SYNERGISTIC extension of their utility. 

And it works.

Ben Reynolds, PA-C
Pittsburgh, PA 

--- JonWalsh at Borgess.com wrote:

> Your requirements (staff service, care for pts, get
> work done, =80 hours) 
> are mutually exclusive - - at least if you want to
> be a surgeon in 5 years 
> that will be allowed to operate on any of my family
> members....
> Our system has done the best it can from the top
> down - - ie, we started 
> with the absolute requirement that whatever was
> going to be done had to 
> comply with the 80 hour requirement...
> so......
>         no residents are in house on Sunday's
>         we've hired more PA's for the private
> practice docs working at our 
> facility to assist them with day to day work (notes,
> initial consults) 
> that the residents can't accomplish
>         we've had to fragment the patient experience
> - - so often, the 
> resident has never met the patient before the
> morning of surgery
>         the residents (chief) decide what cases to
> staff each day to try 
> to fill in all their boxes on the surgery experience
> forms for the 
> board....
>         the attendings are reprimanded by the
> program director if 
> residents exceed the 24 hr in a row rule (+4-6)...
> So in my mind, the system is broken, we are turning
> out less competent 
> surgeons (they may know how to "do" a procedure, but
> they are mediocre at 
> "caring" for patients)
> 
> Just my happy opinion! 
> 
> jcw
> 
> 
> 
> 
> 
> "Ronald Gross" <Rgross at harthosp.org>
> Sent by: trauma-list-bounces at trauma.org
> 01/14/2005 12:54 PM
> Please respond to Trauma & Critical Care mailing
> list
> 
> 
>         To:     <trauma-list at trauma.org>
>         cc: 
>         Subject:        Resident hours
> 
> 
> OK - a change in subject.  And now we see the true
> effect of government
> oversight....
> Does anyone have a workable template for housestaff
> work schedules that
> actually staffs their service, cares for patients,
> gets the work done,
> and MOST IMPORTANTLY (of course) satisfies the
> government-mandated (OK
> so I am taking license with who really imposed this)
> 80 work week?
> Ron
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